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I was greatly
moved by the information shared by members of
ASCR throughout the conference last September.
In the wake of Katrina, Rita and Wilma, stress
management has become vital to the functioning
of employees doing cleanup and restoration after
these hurricanes. Disaster, death and violence
are incidents that are directly linked to Posttraumatic
Stress Disorder. The reduction of long-term
effects and hidden emotional damage caused by
such incidents should be an issue addressed
by all companies involved in trauma response.
It is easy to say that our employees will "get
over it" in time, but all of us are prone
to Posttraumatic Stress Disorder if the circumstances
are right. Psychological distress can be hidden,
leaving us exposed to cumulative stress reactions.
If the stress continues to build up, our bodies
develop stress-related symptoms and physical
illness results.
We normally deny, ignore or
minimize all kinds of stress: however, disasters,
acts of terrorism, death of colleagues and death
of children all disrupt our basic belief that
we are safe and secure. We want to believe that
we can face any situation and that we have all
the tools we need for coping. Therefore, it
is easier to deny stress than to admit that
our tools do not fit the situation or our needs.
When we are suddenly confronted by a traumatic
and shattering experience, our safe and secure
world can collapse, resulting
in: fear and confusion, the loss of our belief
systems, self-worth and value as human beings.
If our equilibrium is not restored,
depression, a sense of pointlessness and even
suicide can result. If our response to stress
continues to build up over time, we develop
cumulative stress reactions, resulting in stress-related
symptoms and illnesses. Untreated stress can
cause a slowing of the immune system. Organs
give way to progressive destruction. The results
are manifested in a range of disorders and diseases
ranging from heart attacks to cancer.
We live with general stressors
and stress symptoms from the moment we wake
until we go to bed. Stress is brought on by
the events and demands in our lives and our
actions and reactions to these events. Stress
has its inception both outside of us -in
the work we do- and within us-our response
to work. The management of stress involves
working with our selves and these events and
demands. The focus of incident stress management
is to change our thinking and reactions to stressful
events so that stress can work for us in a positive
way.
Understanding the stress response
can help employers recognize when an employee
is in trouble. I have encountered four stages
to incident stress.
Stage of Anticipation
comes right after we are notified of the incident.
Anticipatory stress deals with the unknown.
We have no idea of what we are facing and no
idea of what to expect. In this stage, we doubt
ourselves and our ability to be able to do the
job.
The media plays an important
part in this stage and can often terrify our
psyche into believing we are incompetent because
the incident is "too overwhelming".
We forget that the media plays up the worst
events, leaving us to believe that the critical
incident is earth shattering.
Stage of Reality Shock
develops when we arrive at the site. Often we
are overwhelmed by the task at hand. This stage
brings anxiety, a sense of shock, a feeling
that we cannot do enough to help. Also, this
stage can lead to the need to work feverishly.
A fireman who worked after 9/11 told me he was
driven to dig with his hands, since he did not
have a shovel. It was only after he saw that
his hands were bleeding that he realized what
he was doing. This stage defines the abnormal
event in terms of mental traumatization.
Stage of Desperation/Stage
of Acute Reactions develops after the
job is completed. It is normal to push physical
and psychological stress out of the way until
the job is done. After we complete a difficult
task, withdrawing, feeling abandoned or "different",
and having thoughts that no one understands
are all normal perceptions of an abnormal situation.
Feelings of depression, anguish, remorse and
sadness can result. Talking about the incident
becomes difficult, and we become introspective.
We start questioning our belief systems, our
lives, our faith and who we are. We feel guilty
because we did not do enough. We become vulnerable,
and our world as we knew it has collapsed. These
post-traumatic stress reactions are normal responses
to abnormal events.
However, in this stage we can
lose a purpose for living, and this sense of
pointlessness can lead to suicide. It is also
this stage that can lead to affect disintegration:
chronic illness emerges, psychotic episodes
develop, loss of trust shatters meaningful attachments,
chronic guilt and self-blame becomes intrusive.
Relative, friends and colleagues do not want
to hear about the incident and we feel that
they no longer are giving support. As a result,
loneliness and isolation can develop. What can
emerge is Posttraumatic Stress Disorder (PTSD).
The degree of stress experienced is proportional
to these five factors:
1. The amount of empathy one possesses
2. Past traumatic events one has experienced
3. Unresolved traumatic conflicts one may
harbor
4. The amount of exposure to family, children's
or friends' trauma
5. The degree of maladaptive responses one
uses as a survival strategy
Number two addresses cumulative
stress. Cumulative stress compounded by a catastrophe
can cause emotional and physical breakdown.
Cumulative stress is subtle and often ignored,
denied and minimized because the stress starts
to feel normal. Unfortunately, major life changes
develop. Marital problems rank first as the
inducing factor to a cumulative stress response.
It is often easier to blame an event than to
make life changes. If our response to stress
continues to build up, our bodies develop stress-related
symptoms and illness results.
Stage of Reconciliation/Stage
of Acute Posttraumatic Stress is when
we live through and learn from our stress. The
underlying attitude an individual brings to
a stressful situation largely determines whether
the stress will be used for growth or be debilitating.
In this stage we can grow from the traumatic
event and incorporate it into our psyche, or
we can develop acute Posttraumatic Stress Symptoms.
Distress during the days that follow the incident
resemble those of PTSD; however, it is difficult
to differentiate between normal responses to
an abnormal incident and responses that develop
into PTSD.
Terrorism is a new form of incident
stress that demands more than adaptation and
coping. The stress of terrorism necessitates
a confrontation with the threat of helplessness,
death and mutilation. Another element to the
entity of trauma is the way the incident and
past incidents become a way to haunt the individual's
functioning in the present. The results are
fear and uncertainty because the sequential
stressors have a cumulative effect. Oklahoma
City, Columbine and September 11 represent an
assault on our sense of personal safety and
belief in humanity. This shattering of beliefs
can traumatize the individuals in the restoration
field to a greater degree than what is experienced
by a primary victim because it is cumulative,
group related, ongoing, affects the functioning
of a group, and is often viewed as individual
pathology and not as an "event that happened
to the United States of America". There
is a cost to caring and the price can be individual,
as well as large group disintegration.
In short, it is easy for every
one of us to set ourselves up for stress reactions.
Without normalizing the situation, we have no
idea that the symptoms we exhibit are symptoms
the normal population would express. We cannot
always change the events and demands in our
daily lives, but we can change our way of looking
at those events and our reaction to stressful
demands.
In my book, Cumulative Stress
Management for Search and Rescue: A Workbook
for all Emergency Personnel, the
premise is simple: We all need to practice ways
in which we can define ourselves by our typical
moments and not our worst moments. This key
to surviving incident stress is paramount to
our functioning because it puts us in control.
The acceptance and insight into who we are and
how we respond to stress are keys to our mental
health. In other words, learning to grow from
stress reactions, finding ways to deal with
uncertainty, meditation and relaxation, coming
to terms with death, taking care of our bodies
physically, and helping our loved ones cope
with the stress are all critical "defusers"
to stress management for emergency workers.
Since I believe that every one of us needs to
take responsibility for our ongoing health,
having tools to reduce our stress is the key
to prevention.
So, what is the answer? Studies
have shown that training for stressful events
protects individuals from the effects of stress.
Ongoing training can reduce uncertainty, increase
one's sense of control, and teach automatic
responses. Training is effective in generating
positive response outcome. * Reading positive
affirmations concerning one's abilities enroute
to the incident can also have the same effect
in reducing uncertainty. **
The urgency to prepare our personnel
for future man-made disasters and acts of terrorism
so that psychological effects will be minimal
is paramount. We need to reexamine our procedures
so that our employees are protected from environmental
harm during and after their work. Since interventions
concerning man-made disasters are different
from natural disasters, we need to focus on
this new frontier: terrorism and human-constructed
disasters. Oklahoma City and September 11 were
America's largest man-made horror shows. The
very thought that we could become a battleground
to terrorism devastates the normal American
concept of good will. Let us use what we have
learned from these events and develop positive
scenarios for the future. Hopefully time and
and preparation will increase our knowledge
and lessen the impacts of future disasters.
Marilyn Neudeck-Dicken,
Ph.D. is a pioneer in the area of traumatic
stress and has decades of experience based on
extensive research and firsthand knowledge.
She has been involved in incidents such as the
Oklahoma City bombing, four Mobil explosions,
the Columbine shootings, and the Cerritos and
San Diego plane crashes. She can be reached
at drmend2@yahoo.com.
References:
*Chemtob et al.1990; Hytten 1989'
**Neudeck-Dicken, 1997
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